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Arrhythmia

Overview

A heart arrhythmia (uh-RITH-me-uh) is an irregular heartbeat. Heart rhythm problems (heart arrhythmias) occur when the electrical signals that coordinate the heart's beats don't work properly. The faulty signaling causes the heart to beat too fast (tachycardia), too slow (bradycardia) or irregularly.

Heart arrhythmias may feel like a fluttering or racing heart and may be harmless. However, some heart arrhythmias may cause bothersome — sometimes even life-threatening — signs and symptoms.

However, sometimes it's normal for a person to have a fast or slow heart rate. For example, the heart rate may increase with exercise or slow down during sleep.

Heart arrhythmia treatment may include medications, catheter procedures, implanted devices or surgery to control or eliminate fast, slow or irregular heartbeats. A heart-healthy lifestyle can help prevent heart damage that can trigger certain heart arrhythmias.

Symptoms

An arrhythmia can be silent, meaning you don't notice any symptoms. Your doctor may spot an uneven heartbeat during a physical exam.


If you have symptoms, they may include:

  • Palpitations (a feeling of skipped heartbeats, fluttering, or "flip-flops")
  • Pounding in your chest
  • Dizziness or feeling lightheaded
  • Fainting
  • Shortness of breath
  • Chest pain or tightness
  • Weakness or fatigue (feeling very tired)
  • Anxiety
  • Blurry vision
  • Sweating

Types

There are several types of arrhythmia, as described here:

Atrial fibrillation

This is the irregular beating of the atrial chambers, and nearly always involves tachycardia. Atrial fibrillation (A-fib) is common and mainly develops in adults over 65 years of age.

Instead of producing a single, strong contraction, the chamber fibrillates, or quivers, often producing a rapid heartbeat.

Atrial flutter

While fibrillation causes many random and different quivers in the atrium, atrial flutter is usually from one area in the atrium that is not conducting properly. This produces a consistent pattern in the abnormal heart conduction.

Some people may experience both flutter and fibrillation.

Atrial flutter can be a serious condition and usually leads to fibrillation without treatment.

Supraventricular tachycardia

The condition known as supraventricular tachycardia (SVT) refers to a rapid but rhythmically regular heartbeat. An individual can experience a burst of accelerated heartbeats that can last from a few seconds to a few hours.

Doctors classify atrial fibrillation and flutter under SVTs.

Ventricular tachycardia

This condition refers to abnormal electrical impulses that start in the ventricles and cause an abnormally fast heartbeat. This often happens if the heart has a scar from a previous heart attack.

Ventricular fibrillation

This is an irregular heart rhythm consisting of rapid, uncoordinated, and fluttering contractions of the ventricles. The ventricles do not pump blood but quiver instead.

Ventricular fibrillation can be life threatening and usually has links to heart disease. A heart attack often triggers it.

Find out more about ventricular fibrillation here.

Long QT syndrome

This syndrome refers to a heart rhythm disorder that sometimes causes rapid, uncoordinated heartbeats. This can result in fainting, which may be life threatening.

It can also occur due to genetic susceptibility or taking certain medications.

causes

Arrhythmias can be caused by:

  • Coronary artery disease
  • High blood pressure
  • Changes in the heart muscle (cardiomyopathy)
  • Valve disorders
  • Electrolyte imbalances in the blood, such as sodium or potassium
  • Injury from a heart attack
  • The healing process after heart surgery
  • Other medical conditions
  • Diagnosis

To diagnose arrhythmias, your doctor can use:

  • your medical and family history
  • a physical exam
  • a range of tests to diagnose arrhythmias

In addition to an ECG, your doctor may also use a chest x-ray or echocardiography to check:

  • the size and shape of your heart
  • the condition of the valves that help regulate the flow of blood through your heart

Since arrhythmias can be irregular and may not occur while you’re at the doctor’s office, your doctor may have you use a heart monitor at home. Types of monitors include:

  • Holter monitor. A holter monitor is a portable monitor that records your heart’s rhythm over the course of one or two days.
  • Event recorders. Event recorders are handheld monitors that can be used to record your heartbeat when you feel an irregularity.
  • Implantable loop recorder. Your doctor may implant a loop recorder under your skin to continuously monitor your heartbeat and record infrequent arrhythmias.

Other tests can also check for an arrhythmia in various situations. These include:

Stress test. A stress test allows your doctor to monitor your heartbeat while you exercise to see if exertion causes an arrhythmia. They can also use medication to increase your heart rate for the test if you have trouble exercising.

Sleep study. A sleep study can show whether sleep apnea is the source of your arrhythmia.

Tilt table test. A tilt table test may be used if your arrhythmia has caused you to faint in the past. Your doctor will check your heart rate and blood pressure as you lie on a table that’s tilted between different positions.

Electrophysiological testing. Your doctor will insert thin electrode catheters through your veins to different areas on your heart to map electrical signals during electrophysiological testing. The electrodes can also cause arrhythmias, which may help your doctor diagnose them and suggest treatments.

Your doctor may also order blood tests to check the level of magnesium, calcium, thyroid hormone, and other substances in your blood that may affect arrhythmia.

Prevention

Arrhythmias can develop from a variety of causes, some of which you may not be able to prevent. Still, you can work to avoid triggering your arrhythmia or making it worse.

First, it’s important to understand the cause of your arrhythmia so you can avoid triggers. Preventable triggers may include:

  • stress/anxiety
  • smoking
  • caffeine
  • alcohol
  • certain medications
  • some street drugs

Talk to your doctor if you think any medications are causing your arrhythmia. Don’t stop taking or change your medication on your own.

A healthy lifestyle is also helpful for preventing and managing arrhythmia. Do your best to:

  • follow a healthy diet with reduced salt and fat
  • if you smoke, stop smoking
  • exercise regularly
  • stay within a healthy weight range
  • reduce stress
  • limit the amount of alcohol you drink
  • maintain healthy blood pressure and cholesterol levels

Develop a plan with your doctor to help you manage your arrhythmia, including steps you can take when you have symptoms.

Risk factors

Your family history, health conditions, age, lifestyle, and more can be risk factors for developing arrhythmia.

Medical conditions or events, particularly ones related to your heart, may increase your risk. They include:

coronary artery disease

  • heart valve disease
  • heart attack or heart failure
  • cardiomyopathy (heart muscle diseases)
  • endocarditis (heart inflammation)
  • high blood pressure
  • sleep apnea
  • chronic lung disease
  • overactive or underactive thyroid gland
  • kidney disease
  • eating disorders that cause an electrolyte imbalance or malnutrition
  • fever
  • diabetes

Other common risk factors include:

  • older age
  • certain medications, especially stimulants and antihistamines some of which can be found over the counter
  • air pollution
  • family history of arrhythmia
  • caffeine
  • alcohol
  • smoking
  • street drugs, particularly cocaine or amphetamines
  • Lifestyle changes may help lower your chances of developing an arrhythmia.

Learn more about arrhythmia risk factors and how to reduce them.

Complications

Different types of arrhythmias, especially when untreated, may lead to life threatening conditions. These complications include:

  • heart failure
  • stroke
  • dementia
  • cardiac arrest
  • arrhythmias that get worse or cause other symptoms

A 2014 study indicated that several conditions, including arrhythmia, were strongly associated with dementia in adults older than age 64.

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